NPI | 1417043597 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 00001980) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 5303) |
363AM0700X Physician Assistant, Medical (Licence: WA PA10004662) | |
363A00000X Physician Assistant (Licence: OR PA153806) | |
Enumeration Date | 2006-10-05 |
Last Update Date | 2025-03-15 |